1. Vital Signs Lesson 2: Temperature35
Vital Signs
Lesson 2:
Temperature

2. Lesson Objectives
Upon completion of this lesson, students should be able to …
Define and spell the terms to learn for this chapter.
Convert temperature readings from degrees Fahrenheit (F) to degrees Centigrade (C) (and vice versa).
State the normal values of temperature, pulse, respiratory rates, and blood pressure.

3. Lesson Objectives
List ten conditions that cause the body temperature to increase or decrease.
State three situations in which measuring an oral, rectal, and axillary temperature should be avoided.

4. Vital Signs Temperature (T) Pulse (P) Respiration (R)
Blood pressure (BP)
Pain 4

5. Taking a Patient’s Temperature: What the Medical Assistant Must Know
How the body balances heat production and loss
What is a normal temperature reading
Factors that influence temperature readings
How to select and use the proper thermometer
How to clean and care for equipment 5

6. Temperature Values Average body temperature of a healthy person
98.6°F or 37°C
Temperatures can vary
by 1°F ( 0.6°C) during the day 6

7. Factors Affecting Body Temperature
Time of day
Age
Gender
Physical exercise
Emotions
Pregnancy
Environmental changes
Infection
Drugs
Food 7

8. Fever Also known as pyrexia A body temperature above 100.4°F (38°C)
Indicates that the body is producing greater heat then what is being lost
Indicates that the body is febrile
Hyperpyrexia or hyperthermia develops if temperature exceeds 105.8°F (41°C)
A temperature above 109.4°F (43°C) is typically fatal 8

9. Common Types of Fevers Intermittent fever Remittent fever
Relapsing fever
Constant fever 9

10. Signs of a Fever Increased heart rate Increased respiratory rate
Shivering
Chills
Sweating
If hyperthermia is present symptoms can include cessation of sweating, loss of coordination, drowsiness, and convulsions 10

11. Hypothermia Temperature below 97°F (36°C) Below 93.2°F (34°C) is fatal
Clinical signs of hypothermia
Decreased pulse and respirations
Pale, waxy, cool skin
Lack of muscle coordination
Drowsiness progressing to coma and death 11

12. Fahrenheit and Centigrade Thermometers12

13. Converting Fahrenheit and Centigrade
To convert Fahrenheit to Centigrade
Subtract 32 (from °F) and multiply by 5/9
(F° − 32) × 5/9 = °C
To convert Centigrade to Fahrenheit
Multiply °C by 9/5 and add 32
(°C × 9/5) + 32 = °F 13

14. Sites for Measuring Body Temperature
Oral: For most adults and children who can follow instructions
Rectal: For infants and small children, patients who have had oral surgery, mouth-breathing patients, and unconscious patients
Axillary: For small children
Ear (aural): For small children
Temporal artery: For infants and small children 14

15. Normal Temperature Values
Oral–98.6F (37C)
Rectal–99.6F (37.6C)
Axillary–97.6F (36.4C)
Ear (aural)–98.6F (37C)
Temporal artery–98.6F (37C) 15

16. Critical Thinking Question
What might cause you to select one method versus another to take a patient’s temperature?

17. Considerations When Taking an Oral Temperature
Some facilities do not require the designation “O” when documenting this measurement
The patient may not form a tight closure over the thermometer – This allows air to enter the mouth and give a false temperature reading
The thermometer is inserted under the tongue on either side of the frenulum linguae

18. Considerations When Taking an Oral Temperature
For an accurate measurement, the patient must be advised not to talk during the procedure
Oral temperature should only be measured if 15 minutes have passed since the patient has taken fluids or smoked

19. When Not to Use the Oral Method
Patients who have had oral surgery, mouth sores, or dyspnea
Uncooperative patients
Patients on oxygen
Infants and small children
Patients with facial paralysis or nasal obstruction

20. Considerations for Taking an Aural Temperature
One of the newer technologies for accurate temperature
Method uses the tympanic membrane area at the end of the external auditory canal for an instantaneous temperature measurement

21. Considerations for Taking an Aural Temperature
Some of the reasons this is an accurate method for temperature measurement are:
The tympanic thermometer provides a closed cavity within the easily accessible ear
Tympanic thermometers are able to detect heat waves in the ear canal and calculate body temperature from the data

22. Considerations for Taking an Axillary Temperature
Axillary temperatures register 1°F (0.6°C) lower than oral temperatures
The axillary method:
Has proven to be the least accurate of the temperature measurement sites
Is recommended for small children
Is recommended for patients who have had oral surgery, any situation in which the patient may bite the oral thermometer, and mouth-breathing patients
Is affected by perspiration – The underarm area should be dry for an accurate reading

23. Considerations for Taking a Rectal Temperature
The temperature obtained through the rectal method registers 1°F (or 0.6°C) higher than the oral temperature
Rectal route is:
Considered more reliable than the oral method
Advised for unconscious patients, infants, small children, and mouth-breathing patients
Not recommended when there is a danger of rectal wall perforation

24. Considerations for Taking a Temporal Artery Temperature
A new noninvasive procedure involving a device that measures the temperature over the temporal artery
Temporal artery is located close to the skin surface on the forehead and temple area
When the probe/scanner is passed over the surface of the forehead toward the temple it can read the peak arterial temperature value

25. Types of Thermometers Non-mercury glass Electronic Tympanic membrane
Disposable 25

26. Reading a Thermometer 26

27. Using Thermometer Sheaths27

28. Steps in Taking an Oral Temperature Using an Electronic Thermometer
Step 1: Perform hand hygiene.
Step 2: Assemble equipment.
Step 3: Identify the patient and explain the procedure.
Step 4: Remove the thermometer unit from the
base and attach the probe (blue for oral).
Step 5: Remove the thermometer probe from the holder. 28

29. Steps in Taking an Oral Temperature Using an Electronic Thermometer
Step 6: Insert the thermometer probe into the disposable
tip box to secure the tip.
Step 7: Insert into patient’s mouth on either side of the
frenulum linguae and instruct patient to close mouth.
Step 8: When temperature signal is seen or heard,
remove and read the results in the LED window.
Step 9: Dispose of the thermometer tip in a waste container.
Step 10: Return thermometer probe to the
storage place. 29

30. Steps in Taking an Oral Temperature Using an Electronic Thermometer
Step 11: Replace the unit on the rechargeable base.
Step 12: Perform hand hygiene.
Step 13: Document the results. 30

31. Steps in Measuring a Rectal Temperature
Perform hand hygiene
Apply gloves
Identify the patient
Explain the procedure – If the patient is a child, explain the procedure to both the parent and the child
Instruct the patient to remove appropriate clothing so that the rectal area can be accessed – Provide privacy for the patient

32. Steps in Measuring a Rectal Temperature
Assist the patient onto the examining table and cover with a sheet/drape
Instruct the patient to lay on their left side with top leg bent (Sim’s position)

33. Positioning for the Rectal Temperature

34. Steps for Measuring a Rectal Temperature
Remove electronic thermometer from base and place cover on probe
Place a small amount of lubricant on tissue and dip probe into lubricant
With one hand, raise the upper buttock to expose the anus or anal opening
If unable to see the anal opening, ask the patient to bear down slightly – This will expose the opening

35. Steps for Measuring a Rectal Temperature
With the other hand, gently insert lubricated thermometer 1½ inches into the anal canal – Rotating the thermometer may make insertion easier

36. Steps for Measuring a Rectal Temperature
Hold the thermometer in place until result is signaled
Withdraw the thermometer
Dispose of probe cover in a biohazard waste container
Wipe the anus from front to back to remove access lubricant
Assist the patient from the examination table – Instruct the patient to dress and assist if necessary

37. Steps for Measuring a Rectal Temperature
Remove gloves and place them in biohazard waste container
Perform hand hygiene
Record temperature using (R) to indicate rectal reading

38. Steps for Accurately Using the Tympanic Thermometer
Identify the patient – To avoid error, call patient by name and check the name on patient’s record
Explain procedure to patient
Remove the thermometer from its base – The display will read “ready”
Attach disposable probe cover to earpiece

39. Steps in Measuring Temperature Using a Tympanic Thermometer
With one hand, gently pull upward on the patient’s outer ear if an adult or pull back and downward if an infant or child
Gently insert the plastic-covered tip of the probe into the ear canal
Press the scan button, which activates thermometer
Observe the temperature reading in the display window

40. Steps in Measuring Temperature Using a Tympanic Thermometer
Gently withdraw the thermometer
Eject the used probe cover into a biohazard waste container by pressing the eject button

41. Steps in Measuring Axillary Temperature
Perform hand hygiene
Identify the patient
Explain the procedure – If patient is a child, explain procedure to both the parent and child
Remove electronic thermometer from its base and place cover on probe
Ask the patient to expose the axilla – If patient is an infant or child, ask parent to take the child’s arm out of clothing to expose axilla

42. Steps in Measuring Axillary Temperature
Using a tissue, pat the axilla dry of perspiration
Place the probe with cover into the axillary space

43. Steps for Accurately Obtaining an Axillary Temperature
Ask the patient to remain still and hold the arm tightly next to the body while the temperature registers
When the thermometer beeps, remove thermometer and discard the probe in a waste container
The medical assistant can take pulse and respirations while the patient is holding the thermometer under the axilla
Return thermometer to storage base

44. Steps for Accurately Obtaining an Axillary Temperature

45. Steps in Using a Chemical Disposable Thermometer
Identify the patient
Explain the procedure
Dry the patients forehead
Place the thermometer strip on the patient’s forehead
Read the correct temperature by reading the color changes – The reading is taken by noting the highest reading among the dots that changed color – It is held in place for about 15 seconds and is read by the color change on the strip

46. Steps to Using a Temporal Artery Thermometer
Identify the patient
Explain the procedure
Brush the patient’s hair aside
Place the probe flush on the center of the forehead and depress the red button
Keep the button depressed and slowly slide the probe on the midline across the forehead to the hairline

47. Steps to Using a Temporal Artery Thermometer
Lift the probe from the forehead and touch it on the neck just behind the earlobe
Release the button and read the temperature

48. Questions? 48